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Journal articleAcquaah F, Robson Brown KA, Ahmed F, et al., 2015, , Frontiers in Endocrinology, Vol: 6, ISSN: 1664-2392
Early bone development may have a significant impact upon bone health in adulthood. Bone mineral density (BMD) and bone mass are important determinants of adult bone strength. However, several studies have shown that BMD and bone mass decrease after birth. If early development is important for strength, why does this reduction occur? To investigate this, more data characterizing gestational, infant, and childhood bone development are needed in order to compare with adults. The aim of this study is to document early vertebral trabecular bone development, a key fragility fracture site, and infer whether this period is important for adult bone mass and structure. A series of 120 vertebrae aged between 6 months gestation and 2.5 years were visualized using microcomputed tomography. Spherical volumes of interest were defined, thresholded, and measured using 3D bone analysis software (BoneJ, Quant3D). The findings showed that gestation was characterized by increasing bone volume fraction whilst infancy was defined by significant bone loss (≈2/3rds) and the appearance of a highly anisotropic trabecular structure with a predominantly inferior–superior direction. Childhood development progressed via selective thickening of some trabeculae and the loss of others; maintaining bone volume whilst creating a more anisotropic structure. Overall, the pattern of vertebral development is one of gestational overproduction followed by infant “sculpting” of bone tissue during the first year of life (perhaps in order to regulate mineral homeostasis or to adapt to loading environment) and then subsequent refinement during early childhood. Comparison of early bone developmental data in this study with adult bone volume values taken from the literature shows that the loss in bone mass that occurs during the first year of life is never fully recovered. Early development could therefore be important for developing bone strength, but through structural changes in trabec
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Book chapterHalewood C, Masouros S, Amis AA, 2015,
Structure and function of the menisci
, Meniscal Allograft Transplantation. A comprehensive review., Editors: Getgood, Spalding, Cole, Gersoff, Verdonk, ISBN: 978-0-9558873-5-2 -
Journal articlePapi E, Osei-Kuffour D, Chen Y-MA, et al., 2015, , Medical Engineering & Physics, Vol: 37, Pages: 698-704, ISSN: 1873-4030
The prevalence of osteoarthritis is increasing globally but current compliance with rehabilitation remainspoor. This study explores whether wearable sensors can be used to provide objective measures of performancewith a view to using them as motivators to aid compliance to osteoarthritis rehabilitation. Morespecifically, the use of a novel attachable wearable sensor integrated into clothing and inertial measurementunits located in two different positions, at the waist and thigh pocket, was investigated. Fourteen healthy volunteerswere asked to complete exercises adapted from a knee osteoarthritis rehabilitation programme whilstwearing the three sensors including five times sit-to-stand test, treadmill walking at slow, preferred and fastspeeds. The performances of the three sensors were validated against a motion capture system and an instrumentedtreadmill. The systems showed a high correlation (r2 > 0.7) and agreement (mean difference range:−0.02–0.03 m, 0.005–0.68 s) with gold standards. The novel attachable wearable sensor was able to monitorexercise tasks as well as the inertial measurement units (ICC > 0.95). Results also suggested that a functionalplacement (e.g., situated in a pocket) is a valid position for performance monitoring. This study showsthe potential use of wearable technologies for assessing subject performance during exercise and suggestsfunctional solutions to enhance acceptance.
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Book chapterHalewood C, Lumpaopong P, Stephen JM, et al., 2015,
Functional Biomechanics with Cadaver Specimens
, Experimental Research Methods in Orthopedics and Trauma, Editors: Simpson, Augat, Publisher: Thieme Medical Publishers, ISBN: 9783131731111This book provides a comprehensive summary of all current research methodologies for translational and pre-clinical studies in biomechanics and orthopedic trauma surgery.
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Journal articleHalewood C, Amis AA, 2015, , Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 23, Pages: 2789-2796, ISSN: 0942-2056
The paper describes the concepts of primary and secondary restraints to knee joint stability and explains systematically how the tibia is stabilised against translational forces and rotational torques in different directions and axes, and how those vary across the arc of flexion–extension. It also shows how the menisci act to stabilise the knee, in addition to load carrying across the joint. It compares the properties of the natural stabilising structures with the strength and stiffness of autogenous tissue grafts and relates those strengths to the strength of graft fixation devices. A good understanding of the biomechanical behaviour of these various structures in the knee will help the surgeon in the assessment and treatment of single and multi-ligament injuries.
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Journal articleKwasnicki RM, Ali R, Jordan SJ, et al., 2015, , International Journal of Surgery, Vol: 18, Pages: 14-20, ISSN: 1743-9191
BackgroundTotal knee replacement currently lacks robust indications and objective follow-up metrics. Patients and healthcare staff are under-equipped to optimise outcomes. This study aims to investigate the feasibility of using an ear-worn motion sensor (e-AR, 51³Ô¹ÏÍø) to conduct objective, home-based mobility assessments in the peri-operative setting.MethodsFourteen patients on the waiting list for knee replacement, and 15 healthy subjects, were recruited. Pre-operatively, and at 1, 3, 6, 12 and 24 weeks post-operatively, patients underwent functional mobility testing (Timed Up and Go), knee examination (including range of motion), and an activity protocol whilst wearing the e-AR sensor. Features extracted from sensor motion data were used to assess patient performance and predict patients' recovery phase.ResultsSensor-derived peri-operative mobility trends correlated with clinical measures in several activities, allowing functional recovery of individual subjects to be profiled and compared, including the detection of a complication. Sensor data features enabled classification of subjects into normal, pre-operative and 24-week post-operative groups with 89% (median) accuracy. Classification accuracy was reduced to 69% when including all time intervals.DiscussionThis study demonstrates a novel, objective method of assessing peri-operative mobility, which could be used to supplement surgical decision-making and facilitate community-based follow-up.
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Journal articlevan Arkel RJ, Amis AA, Cobb JP, et al., 2015, , Bone & Joint Journal, Vol: 97B, Pages: 484-491, ISSN: 2049-4394
In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty.
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Conference paperBahsoun AN, Sugand K, Mawkin M, et al., 2015,
Validation of touch surgery, a surgical cognitive task trainer
, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 20-20, ISSN: 0007-1323 -
Conference paperSugand K, Boyer N, Sarraf K, et al., 2015,
Using online mutlimedia to teach orthopaedic trauma emergencies
, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 34-34, ISSN: 0007-1323 -
Conference paperStephen JM, Halewood C, Kittl C, et al., 2015,
The influence of posterior medial meniscocapsular lesions on tibiofemoral joint laxity in ACL deficient and reconstructed knees
, British Association of Surgery of the Knee -
Journal articleAkhtar K, Sugand K, Wijendra A, et al., 2015, , Patient Safety in Surgery, Vol: 9, ISSN: 1754-9493
BACKGROUND: Simulation allows training without posing risk to patient safety. It has developed in response to the demand for patient safety and the reduced training times for surgeons. Whilst there is an increasing role of simulation in orthopaedic training, the perception of patients and the general public of this novel method is yet unknown. Patients and the public were given the opportunity to perform a diagnostic knee arthroscopy on a virtual reality ARTHRO Mentor simulator. After their practice session, participants answered a validated questionnaire based on a 5-point Likert Scale assessing their opinions on arthroscopic simulation. Primary objective was observing perception of patients on orthopaedic virtual reality simulation. FINDINGS: There were a total of 159 respondents, of which 86% were of the opinion that simulators are widely used in surgical training and 94% felt that they should be compulsory. 91% would feel safer having an operation by a surgeon trained on simulators, 87% desired their surgeon to be trained on simulators and 72% believed that additional simulator training resulted in better surgeons. Moreover, none of the respondents would want their operation to be performed by a surgeon who had not trained on a simulator. Cronbach's alpha was 0.969. CONCLUSIONS: There is also a clear public consensus for this method of training to be more widely utilised and it would enhance public perception of safer training of orthopaedic surgeons. This study of public perception provides a mandate to increase investment and infrastructure in orthopaedic simulation as part of promoting clinical governance.
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Journal articleCampbell IC, Coudrillier B, Mensah J, et al., 2015, , JOURNAL OF THE ROYAL SOCIETY INTERFACE, Vol: 12, ISSN: 1742-5689
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Journal articleKawaguchi Y, Kondo E, Takeda R, et al., 2015, , ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, Vol: 31, Pages: 435-444, ISSN: 0749-8063
PurposeThe purpose was to clarify the load-bearing functions of the fibers of the femoral anterior cruciate ligament (ACL) attachment in resisting tibial anterior drawer and rotation.MethodsA sequential cutting study was performed on 8 fresh-frozen human knees. The femoral attachment of the ACL was divided into a central area that had dense fibers inserting directly into the femur and anterior and posterior fan-like extension areas. The ACL fibers were cut sequentially from the bone: the posterior fan-like area in 2 stages, the central dense area in 4 stages, and then the anterior fan-like area in 2 stages. Each knee was mounted in a robotic joint testing system that applied tibial anteroposterior 6-mm translations and 10° or 15° of internal rotation at 0° to 90° of flexion. The reduction of restraining force or moment was measured after each cut.ResultsThe central area resisted 82% to 90% of the anterior drawer force; the anterior fan-like area, 2% to 3%; and the posterior fan-like area, 11% to 15%. Among the 4 central areas, most load was carried close to the roof of the intercondylar notch: the anteromedial bundle resisted 66% to 84% of the force and the posterolateral bundle resisted 16% to 9% from 0° to 90° of flexion. There was no clear pattern for tibial internal rotation, with the load shared among the posterodistal and central areas near extension and mostly the central areas in flexion.ConclusionsUnder the experimental conditions described, 66% to 84% of the resistance to tibial anterior drawer arose from the ACL fibers at the central-proximal area of the femoral attachment, corresponding to the anteromedial bundle; the fan-like extension fibers contributed very little. This work did not support moving a single-bundle ACL graft to the side wall of the notch or attempting to cover the whole attachment area if the intention was to mimic how the natural ACL resists tibial displacements.Clinical RelevanceThere is ongoing debate about ho
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Journal article, 2015, , Br J Hosp Med (Lond), Vol: 76, ISSN: 1750-8460
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Journal articleKittl C, Halewood C, Stephen JM, et al., 2015, , American Journal of Sports Medicine, Vol: 43, Pages: 354-362, ISSN: 0363-5465
Background:Lateral extra-articular soft tissue reconstructions in the knee may be used as a combined procedure in revision anterior cruciate ligament surgery as well as in primary treatment for patients who demonstrate excessive anterolateral rotatory instability. Only a few studies examining length change patterns and isometry in lateral extra-articular reconstructions have been published.Purpose:To determine a recommended femoral insertion area and graft path for lateral extra-articular reconstructions by measuring length change patterns through a range of knee flexion angles of several combinations of tibial and femoral insertion points on the lateral side of the knee.Study Design:Controlled laboratory study.Methods:Eight fresh-frozen cadaveric knees were freed of skin and subcutaneous fat. The knee was then mounted in a kinematics rig that loaded the quadriceps muscles and simulated open-chain knee flexion. The length changes of several combinations of tibiofemoral points were measured at knee flexion angles between 0° and 90° by use of linear variable displacement transducers. The changes in length relative to the 0° measurement were recorded.Results:The anterior fiber region of the iliotibial tract displayed a significantly different (P < .001) length change pattern compared with the posterior fiber region. The reconstructions that had a femoral insertion site located proximal to the lateral epicondyle and with the grafts passed deep to the lateral collateral ligament displayed similar length change patterns to each other, with small length increases during knee extension. These reconstructions also showed a significantly lower total strain range compared with the reconstruction located anterior to the epicondyle (P < .001).Conclusion:These findings show that the selection of graft attachment points and graft course affects length change pattern during knee flexion. A graft attached proximal to the lateral femoral epicondyle and running deep
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Journal articleMacmull S, Gupte CM, 2015, , Orthopaedics and Trauma, Vol: 29, Pages: 6-11, ISSN: 1877-1327
Knee arthroscopy has proved to be a useful tool in the diagnosis of common knee intra-articular pathologies and has become a mainstay of treatment for meniscal, cruciate and chondral disorders of the knee. The aim of this article is to give a brief history of arthroscopic surgery, explain the safe positioning of the patient on the operating table and how to navigate the knee with an arthroscope, and cover the potential complications.
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Journal articleBrewer P, Hand SJ, Archer M, et al.,
New genus of primitive wombat (Vombatidae,Marsupialia) from Miocene deposits in the RiversleighWorld Heritage Area (Queensland, Australia)
, Palaeontologia Electronica -
Conference paperGeraldes D, Hansen U, Amis A, 2015,
Parametric analysis of glenoid implant design
, European Society of Biomechanics 2015 -
Conference paperCoudrillier B, Geraldes D, Nghia V, et al., 2015,
A novel micro-computed tomography method to measure IOP-induced deformation of the lamina cribrosa.
, The Annual Meeting of the Association for Research in Vision and Ophthalmology 2015 -
Conference paperCoudrillier B, Geraldes D, Nghia V, et al., 2015,
Phase-contrast micro-tomography measurements of intraocular pressure-induced deformation of the porcine lamina cribrosa
, Biomechanics, Bioengineering and Biotransport Conference 2015
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